Objective To develop consensus-based recommendations for measures to be taken
by medical and public health professionals if hemorrhagic fever viruses (HFVs)
are used as biological weapons against a civilian population.

Participants The Working Group on Civilian Biodefense included 26 representatives
from academic medical centers, public health, military services, governmental
agencies, and other emergency management institutions.

Evidence MEDLINE was searched from January 1966 to January 2002. Retrieved references,
relevant material published prior to 1966, and additional sources identified
by participants were reviewed.

Consensus Process Three formal drafts of the statement that synthesized information obtained
in the evidence-gathering process were reviewed by the working group. Each
draft incorporated comments and judgments of the members. All members approved
the final draft.

Conclusions Weapons disseminating a number of HFVs could cause an outbreak of an
undifferentiated febrile illness 2 to 21 days later, associated with clinical
manifestations that could include rash, hemorrhagic diathesis, and shock.
The mode of transmission and clinical course would vary depending on the specific
pathogen. Diagnosis may be delayed given clinicians' unfamiliarity with these
diseases, heterogeneous clinical presentation within an infected cohort, and
lack of widely available diagnostic tests. Initiation of ribavirin therapy
in the early phases of illness may be useful in treatment of some of these
viruses, although extensive experience is lacking. There are no licensed vaccines
to treat the diseases caused by HFVs.

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Figures

Figure 1. Maculopapular Rash in Marburg Disease

A nonpruritic maculopapular rash (resembling the rash of measles)
may occur in up to 50% of patients infected with the Ebola or Marburg viruses
within the first week of illness. The rash is more common in light-colored
skin and desquamates on resolution. Reprinted with permission from Thieme
(Martini GA, Knauff HG, Schmidt HA, et al. A hitherto unknown infectious disease
contracted from monkeys. Ger Med Mon. 1968;13:457-470).

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